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Saturday, October 31, 2009

Yesterday I rode Bethany's coat tails, so to speak, to a village visit. I actually rode Luke's bike, and she took Pat's, a few miles down a dirt road, talking and greeting as we bumped along in the spitting rain. Bethany spent several years here as a teacher, and has made regular return visits to work with interns or serve our team, so she is well known (though she did get called Becca once along the way, who taught with Bethany LONG ago). We pushed up hills and avoided goats, gave a wide berth to a teetering inebriated man, laughed at the message on some houses and schools that encouraged "No sweet without sweat" and "No pain no gain". Right. Deep breath and keep pumping.

At last we reached the "pottery house", a homestead of five women who had all been married to one old muslim man who died in August. Mud homes, a well-swept courtyard, two smoldering fires under a tiny poled root-only kitchen, pots-in-the-making lined up under the eaves. The oldest wife recognized Bethany with squeals of delight and called to everyone else as she clapped her hands and hugged Bethany off of her bike. They pulled up the only two low wooden folding chairs for us, and then some stools for others, while the majority sat on mats. Within moments at least twenty kids between the ages of 1 and 10 had materialized to watch us, closely, while we greeted the women. And of course curious neighbors sauntered over to check out the excitement.

This homestead has been an unlikely place of friendship for a series of young women on our team. They asked about their old friends: Carol Logan seemed to be most on their minds, Amina a former secretary for CSB now in school in Kampala, Catherine, Kim, Rachel. We gave news of who was working in Sudan, who was married, who was still in school. Hard to imagine for these women, the way Bethany disappears to another world then returns, with news of all the others. I've only visited a time or two, with one of the others.

But the most fun, for me, was to find one of my patients there. I had forgotten that a daughter of this household came through our PMTCT program and was found to be HIV-infected. She ran into the house to bring her infant Peter out to sit on my lap, an adorable 5-month old with dimples and the thumb-sucking habits of an early-weaner. There by the kitchen hut a Matiti-project goat stood tied. And by the fire was a thermos of recently pasteurized milk. And judging from Peter's cuddliness, not to mention the volume of urine he peed all over my lap, he's getting plenty of goat-milk to drink. We had just sent tests on him from Kwejuna project last week, so I don't yet know his status. But in the evening open-air fireside, holding him, smiling at his young mom, I truly prayed he would turn out to be negative. Sons are the only security for these women, now widows and orphans.

As neighbors enquired, I could hear the women bragging: Bethany is our friend, she slept right there in that house. And Jennifer is the mother of those children, those four. She's the doctor who takes care of the Wednesday patients. She is in charge of the ward for children. If your child is sick she helps you with medicine for free. It is a good place to go. I'm used to being muka-dokta, the doctor's wife. So it was interesting to hear myself talked about by women who knew me as a mom (the thing they were most interested in) and a doctor, at random homestead on a small nowhere road, women of creativity and resilience who were willing to befriend a handful of missionaries, and then found themselves also helped in their time of need. The world is an interesting place.

In a move as old as Adam, the dramas presented by the primary school
students on Thursday were disturbing to watch. They enacted two
parallel families, each having a bevy of girls. But in each family
one of the girls was distinguished by wearing a scarf on her head, and
that particular character was consistently portrayed as bad: she did
not bow low when greeting her elders, she did not respond humbly to
the male teacher, she gave impertinent answers, she did not come
straight home from school with the others, she met boys in the market
and eventually made agreements to meet them for sex. One of the girls
then was shown pregnant, and her mother gave her drugs to abort, and
she died. Rather a sobering morality play for 4th to 7th graders . . .

I was disturbed by several things, watching. First, that the blame
was put solely on the girls. It was their fault that they ended up
pregnant, and then dead. OK there is value in emphasizing that we are
human actors with responsibility, that our actions have consequences,
that we have choices. But the unilateral nature of the blame was
unfair, particularly since girls this age are almost exclusively
preyed upon by older men. Secondly, the young girl playing the mother
who gave the abortive drugs . . . is my neighbor, whom I help with
fees, whose older sister was abused by a teacher two years ago, was
pregnant, had an abortion, and then went through severe depression.
It is heart-breaking to watch kids act out a drama that is so close to
their real life, while the audience hoots and laughs (which I know is
nervous laughter, but still). Lastly, that the drama ended without
hope, in tragedy.

The next day, I was looking through the records of a 2 year old boy on
the ward. The teenage young woman caring for him was wearing the very
same type of scarf that the girls in the play had worn. Which caught
my attention, a symbol or pattern that may indicate God trying to
communicate something. I thumbed back through his book and noted that
he had been in our nutrition program as a motherless baby, and I had
even noted how distraught his young "aunt" was when begging for help
and claiming she could not breast feed him because she had her own
baby at home. Without saying anything, I just started talking to the
caretaker. She made no attempt to hide the fact that she was his
real, biological mother. So this girl had totally lied to us two
years ago, passing off her own child as her nephew (with a letter from
her LC1 to prove it). Something about the scarf though reminded me:
if I don't want others to blame the victim, then I shouldn't either.
So we talked some more. Two years ago she had been a primary grade 6
student at Bundimulinga, our local school. The father of the baby
never married her, he is a trader of some sort in Nyahuka (if we can
believe her now . . . ). She dropped out of school, but still lives
with her parents. Her child looks great, but here she is, unmarried,
raising a child, never finished primary school. Yes, she made poor
choices and later she lied to get the help she thought she needed.
But she's a victim, too, of some man's desire, of poor parental
supervision, of irresponsible adults, of an interrupted childhood, of
grasping for a life she though would be good but turned out to be a lie.

In the garden God calls Adam, Eve, and Satan all to account. There
are consequences, banishment, struggle, sorrow. But ultimately only
Satan will be crushed, and the cost will be borne on the wounded heel
of the awaited One, so that Eve can re-enter Paradise. What wounds
are we called to bear to pull the teenage girls of Bundibugyo back to
life?

Thursday, October 29, 2009

Today Scott took off for Kenya via Kampala, to see the boys play in a soccer tournament this weekend, a joint early birthday present from all our parents. Which meant that someone had to fill his place as the Chief Guest at a day-long Parents' Day and Graduation Party for the Parental Care Primary school, which is directly across the road from the mission. Strangely enough, no one wanted to . . . so it fell to me. Here the kids are processing into the Community Center (their school is down the hill in the background). This primary school had the best PLE scores in the district last year, and is hopeful to repeat their performance this year. It's a brand new school, 340 students crammed into a small mud-crumbly compound. But they seem to be doing some things right. We're prayed for years about primary schools in Bundibugyo. This might be one of the answers.It isn't every day that we have a "marching band". The first couple of hours of this event consisted of a church service, complete with songs, robes, readings, communion. At that early point in the day I felt that community glow: this is precisely Paul's vision for this community center, and Sam Gray would have been happy to see the building full of kids and parents, the Gospel being preached, a major event in which we as missionaries were cheerleading from the sidelines only. Many of the parents are people we know well. I was blessed to participate, except for my initial seating inches in front of massive blaring speakers tortured by too-close microphone holding.
But then the hours went on. And on. I had originally attempted to cut a deal with Ashley: she didn't want to speak, and I said I had no problem speaking, but I didn't want to sit there all day. So she would sit and I would waltz in at the right moment to speak . . . But the event started hours before she was out of school, and by the time she showed up I had been ushered to the front-and-center stage and referred to umpteen times as "Madame Chief Guest" so I was stuck. And as I looked out at the sea of faces above (500?) I was getting more and more nervous about speaking.
Notice the chalk board: my speech is #12 of 13 agenda items, and little half-hour extras like the traditional Bakonjo "kikubba" (chest) dance pictured here were not even considered worth writing up. Choirs, a soap-opera like drama, political representatives, multiple levels of school administration all spoke. And there was almost no English used all day, which meant I had to really work to stay alert and figure out what was going on since at many random moments people would refer to me or ask me something . . .
Let us say that by 5 pm, the event which started at 10 am was still going full blast. When I finally got the microphone, I realized it was so late and so long that no one was particularly going to catch my "sermon" points: that parental care involves provision, sacrifice, and unending commitment, which led into the parallel that God's parental care for us is the same. So instead of just talking, I told a story of a parent who was the youngest of 15, who worked hard to provide for his children and pay school fees . . who of course turned out to be my dad. I would not be here as a doctor speaking in front of 500 Africans unless he had provided and sacrificed and stayed faithful. I hope it was an encouragement to the parents, and pointed people to God.
In the end I realized that my words were minor, compared to just sitting through the day. I wanted to avoid the day-long commitment and just preach. However, what was heard was my presence. No avoiding the sacrifice needed to just listen, clap, smile, encourage, and be present.

Wednesday, October 28, 2009

Bundibugyo has what may be the highest prevalence of Sickle Cell
Anemia in the world. And the kids who don't carry a sickle cell gene
are universally exposed to malaria (which destroys red blood cells and
suppresses their production), universally eat iron deficient diets
(low in meat and animal products), and universally are infested with
intestinal parasites (which suck microscopic amounts of blood
constantly). The result is that almost all kids walk around with a
level of anemia that would cause a panic in any American emergency
room, and the ones who are sick enough to be admitted to our ward
would probably be in a high-level intensive care unit in a place with
the resources. So in a typical day on a 25-bed ward, we probably are
doing anywhere from 3 to 6 blood transfusions. Topping them up, so to
speak, getting that hemoglobin up over a whopping 5 gm/dl, enough to
keep the heart pumping and brain awake.

I've noticed recently, though, that there is an alternative top-up
going on. By my patients' beds I've started seeing bottles of Top Up
ketchup. This is NOT HEINZ, shall we say. I'm not sure any real
tomatoes are involved. It is a gelatinous goo, a cancer-causing red
color, and sweet. But to the very concrete-reasoning patient
population, what looks like blood should be good for making blood, so
I see moms spooning it into their kids. As if they needed another
reason to vomit . .

One of our favorite patients, Aligonilla, has been topped up three
times in the last three days, and yet today is still at only a
hemoglobin of 4.4. He was barely alive at 3, but once he's over 4 he
sits and colors, smiles, talks, plays. This is the child I alluded to
in the gap in blood supply this weekend, when he looked like he could
have died, and if he had done so he would have been the 6th or 7th
child of his father to die, and the 2nd one in three weeks. We've
been struggling for his life since he was born, he's been admitted
numerous times, he can't possibly live a normal lifespan, but for now
he's topped up and back from the brink of death, so we're all relieved.

And all in a day's work: diagnosed a new 4 year old child with AIDS
today, her mother is an articulate lady who actually has a job and
connections but out of fear had refused testing in pregnancy, but when
we saw the girl, moderately malnourished with a chronic draining ear
and huge patches of fungal infection on her skin, we sent her for her
test, which was positive. That was balanced by another 4 year old
whose mother had died . . the Grandmother was sure the child had AIDS
too, and an initial test had been positive, but the confirmatory tests
were all negative, so we just told her to go home and live a normal
life and thank God. Then there was a lady 7 months pregnant with
twins who walked 8 hours from across the border in Congo for an
ultrasound with Scott: he was packing up to leave mid-day when she
arrived, but once he heard the whole story he regretted feeling
frustrated with her lateness! So many stories, these are only a few,
that we feel over-the-top.

Sunday, October 25, 2009

We studied John 10 this week (I am the Good Shepherd), then Psalm 23 (The Lord is my Shepherd) came up in my daily devotional, and this morning at CSB chapel Peter Were commented on one of the songs sung by the choir which the Spirit used to convict his heart about his responsibility as a shepherd. When the theme comes up three times in three days from three directions, it is always a clue that this is important. What is God trying to tell us? For one, that we are NOT the good shepherd, we are simple sheep. We need a protector and a leader, someone well-armed and far-seeing who can be responsible for us. There are many animals one can imagine performing noble rescues or learning tricks. Sheep are not among them. We are helpless to even find our own sustenance. We are clumsy and easily swayed, fearful and unoriginal. The more we see our sheepishness, the more we know our need for the Shepherd. WHM and Paul Miller use this famous cross chart: the more we grasp the depths of our sin and the heights of God's holiness, the bigger the cross becomes, the greater our knowledge of God's power and love. And we're in that sort of a season here: Friday Scott was summoned to a meeting of disgruntled teachers worried about their contracts after the unfiltered consultant report (which suggested cutting the staff size in half to save money) was inadvertently passed on without a careful explanation that we are not planning to take every recommendation as an immediate plan. It all ended well, but again with our team, our patients, our ministries, the sheer complexity of the need makes us practically bleat and run for the fold. And the more we acknowledge that, the more we will see the Shepherd's grace as the true source of success.

So we're sheep. But we're also called to do a bit of surrogate shepherding here. Ez 34 says that God will judge between the sheep .. . and those found abusing the flock in their roles as leaders will be punished. Like the hirelings it is tempting to run when the going gets rough. When there is no blood for transfusion and a child I've known from birth is about to give up his 8 year struggle with sickle cell right in front of my eyes, I'd rather get away. When people aren't happy with the way we've planned or managed something, and feel let down or hurt, it is tempting to avoid them. And like the thieves, I know that my heart often wants to use my colleagues for their gifts or work rather than valuing them for the essence of who they are. We are NOT the Good Shepherd, the One who sacrificially goes ahead to clear the way of all danger, whose voice leads through the palpable darkness of death's shadow.

So what can we do? This morning in church the preacher referred to Jesus as the Lamb of God. It struck me that the Good Shepherd became a sheep, the one sheep who would be sacrificed, bled, cut, eaten. In order for us to grow from sheep towards shepherd. To follow, yes, but to lead others as well, not based on our quality wool or spiffy hooves, but on the power of the life of the Shepherd in us, drawing others into His paths, being led together by Him. So let us be shrinking sheep, aware of our feebleness, but whose lives embody the wisdom and power of the real Shepherd in such a way that HIS grace automatically exudes from us for the good of those we're called to lead.

Thursday, October 22, 2009

276 HIV-positive women, plus several hundred more children, aunts, neighbors, husbands. 122 children evaluated, weighed, reviewed: 16 newly confirmed to be NOT infected, two newly diagnosed HIV-positive. 5 tons of beans. 300 kg of salt. 4 prayer warriors interceding on the side. A couple of dozen volunteers, missionaries and Ugandans, registering, weighing, carrying, testing. 600 cups of porridge, to bide the crowd through the long day. Untold angels enjoying the spectacle of the happy terminally ill meeting together. Pat shared with us the testimony of two of the women: they thanked God for their HIV-infection, because it was the reason they came to know Him. Scott with his check-lists and organization moving the whole process along. Two supporters in New York who never see the blessing they bestow by funding this effort.

This is Dieu-Merci. Her mother quipped that she did not become infected through an HIV-positive husband: she became infected through SOMEONE ELSE"S HIV-positive husband. Hmmmm. When this baby was born, she looked like she needed God's mercy in more than just her name. She was tiny, and hospitalized with a serious infection of her miniscule leg and knee joint. Though her mother had never settled down much before, she took seriously the responsibility of this baby that she never expected to have. She was persistent and aggressive in seeking care. Because of her life-threatening early infection, I had little hope that the baby would turn out to be HIV-negative. But today she had her third and final negative test. She escaped. God's mercy.

Biira Latifa's mother sat at my station looking confused. She did not know the child's birthdate, or even age, and seemed confused on the name. She could not come up with any paperwork to show any previous care or testing. Her vagueness came across as deceit to me, and my quick-to-judge heart suspected fraud (we do get people lying about who they are or their kids are, to try to get food .. . ). I spied an immunization card in her bag and made her pull it out, expecting to prove mistaken identity. But it was the right kid, and the mom seemed embarrassed that she was so flustered. She did not look so well herself, and other women began to tell her what to do. Perhaps she was anxious, or perhaps the HIV has affected her mentally. We sent Biira for testing. An hour later they were back, waiting for the result. I told her that Biira was negative, not infected. She clapped her hands above her head, loudly, praising God and attracting attention. But then she bent down, covered her face with her hands, crying. It made me get tears, too. Here was this mom that I thought was deceitful and incompetent, but she was trembling with relief about her daughter, thankful.

These are two small snapshots of a day full of noise, bustle, facts, figures. Real people with real stories, too numerous to tell: Byaruhanga with his mom Luci, back from months of disappearance. Mumbere with his faithful grandmother, feisty as ever, infected but thriving on ARV's. Another careful mom who begged for yet one more test on her child, too scared to believe the good news until she had it in triplicate over the course of two years. Broken-hearted women asking for prayer for their children left with grandmothers and fathers, because they've been chased away from the family, stigmatized with their infection. Women smiling at each other's children, greeting old friends. Women who have been with us for five years, pressing on. Small struggles in a continent-wide battle against AIDS.

Wednesday, October 21, 2009

When we admit malnourished children, their wilted spirit often mirrors the condition of their body. Most do not bother to protest my exam much, they are listless, apathetic, resigned to a lethargy that began as hunger and is now the atmosphere in which they live. Over days and sometimes weeks, as their sapped energy is replenished by nutritious milk, eggs, and beans, the resurrection which starts from the cellular level eventually expresses itself in eyes calm and widely open, or at long last a smile. We tell the caregivers that this process of recovery requires more than just calories: the children need warmth, human contact, care, love, interest, and play. Their mind and spirit need to be reached even as their body is reviving. Occasionally a nurse will have the time or energy to hold one of the kids, or we might get hand-me-down toys or books from boxes from home, or from team mates. Because most kids don't become malnourished while living with particularly energetic or upstanding adults . . . the caretaker's indifference can be part of the problem. So this month we are happy to welcome a visitor who is a marriage-and-family therapist in the States. Today Karen sat on the floor of the ward, with the bag of toys she brought. Around her were gathered some of our most pitiful little friends: Azibu with AIDS who has increased her size by 50% in the last month after dwindling to near-death levels, or Aligonila with sickle cell disease who has spent his entire life a step away from death, weeks and weeks in the hospital for blood transfusions. Others who I've only seen lying in bed now sat and held a doll. The adults were curious, attentive. We hope that Karen can model healthy playful interaction, in a way that encourages continued work with these children after she leaves. We've asked her to teach at our staff meeting on Friday, too. And meanwhile her husband Dan is absorbing all he can on rounds and in the outpatient department, his training as a PA about half done. They are a couple we would love to see God calling back into Kingdom work in Africa.

And there is a side-story of redemption in these pictures, a staff member who seemed hostile, who seemed reluctant to work, passive-aggressive. In my self-righteousness and judgment I condemned her work-avoidance. Then I talked to another friend for insight about what was going on below the surface, and was reminded that this lady had an infant who died this year, and neither we nor many other staff went to her home to console her or attend the burial. Ouch. Here I am ticking off missed days, and there she is in mourning, feeling bitter. Instead of nagging her, I began to invite her to join in our nutrition work, and one day brought her some books to use in her health education efforts. As she softened, and even smiled at me, I asked her if she'd like to work with Karen this week, and she agreed. Hard to remember sometimes in the midst of chaos and too-much-work, that our colleagues are also human beings, and need the same TLC that the malnourished patients do to draw out their true selves. Not easy for harsh and demanding doctors like me! Lord have mercy.

Monday, October 19, 2009

Monday, the launch of a new week, feeling portentous after the rumbling introduction of Sunday's earthquake. On the cell phone with SIL (Wycliffe translation team) by 6:30 to confirm the lack of rain so that their early AIM-Air flight could land by 8 am. Several Americans and Ugandans stretched their legs and smiled tentatively as they climbed out of the the Caravan airplane, glad to be on the solid ground after the cloudy sky. We loaded up 3000 new copies of Acts in Lubwisi and with Pat transported the team to their first venue. There is a translation consultant here for two weeks to check the book of Romans: like our CSB consultants this summer, a mature Ugandan man, not a foreign missionary, who will go chapter by chapter, verse by verse, through the book with our two translators. Also along for just the day, a literacy group following up on the use of an AIDS-prevention story booklet, and another group of Ugandans who will help develop a Lwamba orthography. Yes, the Lubwisi Bible still leaves out a significant minority of Lwamba speakers, so SIL is launching plans for a second translation project! We left all this in Pat's hands and saw patients for a couple of hours . . then back to the airstrip for the arrival of another flight, this one bringing the smiling faces of Dan and Karen Thrush. Dan is a Physician Assistant Student, and his wife is a marriage-and-family-counselor, and we hope they are both potential long-term Africa missionaries in the future . . at least if a few weeks with us does not discourage them too much. We left them in Nathan's capable care, the hospital in Scott Will and Heidi's hands, and then spent much of the rest of the day at the special welcome ceremony for the new Bishop of the Rwenzori Diocese for the Church of Uganda. This occurred in a a semi-outdoor all-day church service with singing and preaching and prayers. I know some of the theology becomes distorted as we hear it from the periphery . . but from the Bishop himself we heard a humble and Biblical message. In fact the theme of weakness came through again, as he said it was not his wisdom or power that enabled him to serve, but the power of Christ in him. And he challenged the assembled hundreds of people to respond to God's grace by presenting themselves, separating from sin, leading transformed lives, that demonstrate the Gospel (Rom 12:1,2). Probably 80% of the congregation stood and came forward for the altar call, which is frequent here as people respond en masse and feel compelled to do so multiple times. From there it was back to the airstrip to pick up the pilot who had spent the rest of the day in Sudan, some interactions with team mates, and dinner. Ran into CSB teachers who had been monitoring exams . . .Monday was also the first day of O-level exams, the all-important month-long 20-some papers of testing that students must complete to graduate from hight school. And our day ended when we heard our dog making strange choking noises about 10 pm, ran outside to find her straining at her chain because she was being attacked by biting ants. THOUSANDS AND THOUSANDS of them! All over our yard. Scott got out with industrial amounts of ant-killer and did battle. The Kingdom goes forward in outreach, translation, conversions, dedication, health care, schooling . . . but the ants remind us that we're still in enemy territory.

Sunday, October 18, 2009

This morning's sermon was from Acts 18, and new for me, to see that Apollos from the end of the chapter hailed from AFRICA. This was very encouraging to the preacher and others . . the idea that God took this man, who had partial knowledge of the Gospel but was bold and willing to preach, and used him to build the church. The point was that we should expect God to use us even with the little we have to offer--reminded me of the theme of late of strength in weakness, and opened the horizon, that this is not just a phrase for struggling missionaries but perhaps a parable of Africa, an encouragement towards confidence in God's power to use this continent to bless the whole world.

Parenthetically, the service started with a call to repentance, based on the collective experience of a middle-of-the-night earthquake. We were all awakened at 3:39 am by a 5.0 quake--that's strong enough to shake the bed for sure, and rumbly and long enough to send most people running outside. And sobering enough to remind the congregation of eternity!

Friday, October 16, 2009

Last night we watched the Under-20 World Cup Football (soccer) Final match, held in Cairo, between Brazil and Ghana. It was the first time an African team had made it to the finals I think, and a pretty big deal since the World Cup is held next year in South Africa. This was the teen-version of the event, and since many of the best players in the world are 19 or 20 years old, an exciting match, the culmination of around-the world qualifiers and play-offs. We've been able to hook into satellite TV for sports for most of the year now. We don't use it much (time and power are issues!) but it has become a real way to relate to our friends in our home (a missionary justification? oh well, thankful for a little cheering to balance out all the smelly blood-and-guts real missionary work). Our CSB students are on a weekend mid-term break--two had to go back to school after dinner because their major O-level exam period starts Monday, and they are in high-gear. But three stayed for a football sleep-over.

Brazil came out strong, dominating the first half hour. And Ghana looked hesitant, cowed. And I watched our three young footballers, who play for CSB and most every day of their lives, wilting on the couch, bracing for yet another demonstration of Africa's inability to compete and win. I've read some commentary that Africa's crisis is not economic, political, environmental . . . Africa's crisis is a crisis of confidence, a legacy of colonialism, of encountering the rest of the world centuries behind. My heart was wilting with theirs, with the millions of teenage boys just like them all over the continent, watching. When one player was red-carded midway through the first half, in a call the announcers described as "harsh", we all assumed that would be the end and the heavily favored Brazil team would conquer the Ghanaians, who now had to play the rest of the match one man down.

But the game went on, and on. 0 to 0 at the end of the half. 0 to 0 at the end of regulation time. 0 to 0 at the end of the first period of overtime. 0 to 0 at the end of the second period of overtime. The boys from Ghana held on, determined. The hopes of the crowd rose. After 120 minutes of play, the championship went to penalty shoot-outs. And even then, the whole match hung by a thread. Each team scored their first two tries, then Ghana was blocked. It looked like it would be over, then Brazil was blocked. And so it went through the normal 5-shot penalty shoot-out, still tied. The sixth shot for Brazil was taken by the player who had dominated regular play. The keeper from Ghana, who had already had a fantastic game, was seen on his knees praying. Brazil missed, Ghana drove in the final shot, and won 4 to 3 on penalties.

This is the first time an African team has won. I'm sure it was terribly disappointing for Brazil, but frankly they win a lot of football. It was very exciting to watch these boys who look just like our friends, hang on, maintain their poise when they were down, fight hard, and win. Praying it will be a small ripple that spreads across the continent, building confidence.

Thursday, October 15, 2009

Once a year, CSB celebrates Parents' Day, an all-day all-school affair which is the only time that parents come en masse to enjoy and celebrate their childrens' performances, to tour the school, be amazed at the computers, critically inspect the dorms, meet the faculty. As with most things relating to an edge of the Kingdom, there is potential for greatness, and for disaster. Last year was one of the worst Parents' Days ever . . . and this year was one of the best. We prayed that God would be glorified, and that the parents would be pulled into the vision, caught up in what God is doing, confident and loyal. I think both happened. Torrents of rain got the whole day off to a late and slow start, and made me wonder if we were in for another disappointing day. But from start to finish God showed up, in unexpected and clear ways. The student drama, rather than a meandering soap opera, was a well-played story of a man who turned to hospitals and a witch doctor for healing (pretty dramatic scene of incantations) to no avail, and then met a group of Christians who took him for prayer, and important demonstration of God's power being greater than science or spirits. The entire cast came out at the end to recap the story in an original song, pointing to Jesus. Beautiful. Even the "fashion show" which could have been an opportunity for bad taste was scripted by the counselor, a lovely Christian lady, and as the students proudly crossed the stage in outfits from various parts of Uganda the narrative kept pointing to God's creativity. There were choirs and poetry. And traditional dance, which for me and I think most parents was an important statement that we at CSB are not trying to erase culture, and that we value the ancient artistic expression that our students continue to learn and practice. Then of course, no day is complete without speeches, many. And at times these speeches can turn whiny, accusatory, demanding, or inappropriately disrespectful. Not this year. The District Education Office representative is an Inspector of Schools, so when he got up to talk I braced myself for a list of our shortcomings. Instead he launched into a beautiful speech about how Christ School was a demonstration of international commerce: that Americans exported love to start this place. The parents' and students' representatives, who usually present a list of demands, instead spoke very positively (another miracle, the parents' rep was an old man dressed in clothes that clearly identified him with another religion, but he had only good things to say and challenged parents to send ALL their children to Christ School). David reviewed the years' accomplishments, the way that the administration had chosen to consolidate what we are doing and do it better, the improvements in student government, discipline, food, the impact of Scripture Union and a couple of visiting speakers on the spiritual climate, and gave all the statistics on performance on national exams. Scott closed as Chairman of the Board, and did a beautiful job of promoting the sense of ownership of the school by all. He said that we took a long look this year at this 11-year-old . . and like our own 11-year-old, the school is growing but not grown, there are still long ways to go. For this we need two things: prayer, and the wisdom of our elders. Just like an African family calls clan elders to advise, we called two consultants and our mission leadership this year to evaluate the school. He reaffirmed out commitment as a mission to the school, and ended with Psalm 118 again, challenging the parents to have faith, not in US, but in God as the school moves into the next decade of growth, and asked them to join us in prayer specifically for the new Head Teacher.

The students milled about on the edges, the parents listened attentively, laughed and cheered, and patiently sat through the hours of program until the "lunch" was served at about 6 pm. Then we picked our way through the mud, tired and grateful.

The third batch of Christmas-goats went out today, the real beasts that were purchased as tidy decorative ornaments last Christmas. Eighteen more families were blessed. I slipped into the back row first thing this morning, as Pastor Kisembo preached from James about real religion combining faith and love, and God's love being tangibly shown not just in these goats but in the gift of His only child. Lammech and John thanked the women for coming and challenged them to see this blessing as one which they could then return upon others as they brought back the kid-goat offspring. But the highlight for me was Maculate. Early this year she landed on our pediatric ward, the embodiment of the prophecy of the pitiful newborn left in the desert (Ezekiel 16). She had little intact skin from a terrible infection, and we sent HIV tests which came back positive. Her mom was about 16 and almost as pitiful as she was, quite ill and thin and struggling. I thought we should offer compassionate care, but truly believed this baby had little chance of survival, and the mom not much more. Now Maculate is a solid, healthy toddler, miraculously UNinfected. She and her young mom were seated front and center, waiting for their goat. A completely transformed story, a young mom grasping onto life, and a baby who can grow and live. I love seeing the revival of hope.

The first day we reached the ocean, we were too sick to do more than hear the waves. But by the second we could at least drag our selves down to the sand, lie in the shade of the mangroves, read, pray, rest, and watch the surf churning in and out. As beautiful as that was, it was not a real experience of the ocean. For that I had to get into the water, wade past the tangles of sea weed in the shallows and dive into the waves. Bob with the surge of the tide, taste the salt, and swim. Later we sailed and kayaked out further, dipping into the clear warm Indian ocean, exploring with a mask and fins, the mysteries of corals in the shade of passing clouds, the elusive flashes of fish, the waving invitation of algae. I love the ocean. There is a power there, an ever-changing rise and fall, an unpredictability, an infinity. Which is beautiful viewed from the shore, but that view from the safety of the sand lacks fullness and reality. It is safer to stay on the shore and admire, but much more memorable to dive in. And more risky.

I wondered how much of our collective religious approach to God is an attempt to enjoy Him from the shore, to discuss the waves, make tide tables, run for safety in the storm, and dip our toes in the surf when the sun comes out. A good start, but the waves beckon us to plunge.

Wednesday, October 14, 2009

Woke up this morning glad to be home--4:45 am yesterday we were in the Mayfield Guest house in Nairobi, by 9 we had landed in Entebbe and except for having to send Julia through a window in the un-manned guard kiosk to get our keys and rescue our truck from the long-term airport parking, the trip was remarkably smooth. A lot easier when you aren't sick! We wove through traffic to the Capital Shopper's Delight grocery, stocked up as best we could in a short time on food for the next month or so, met up with Sarah and Ashley, and drove back to Bundi before 7 pm: 14 hours door to door, not bad across two countries! We were welcomed by a lovely candlelight dinner hosted by the single men on our team, a balm which soothed the travel-weary day, and emphasized the fellowship of arrival over the loss of departure.

But also woke up this morning to grief, the delayed gut-punch of being a family of four not six. As I lay in the dark, praying for the boys, I knew the tension of two truths: they are in the best place for them right now, right where God has placed them . . . but it is a grief and sacrifice and sadness for us too. God's path does not skirt death's shadows, and after the pastures of the weekend we're back in the valley, walking on. And as I prayed, it hit me that our parents are in the exact same place. The parents of all missionaries. Holding that tension that their kids are where God wants them, but that they bear the grief of that separation. Six more weeks feels long and painful, but my mom has waited over 16 years . . The Gospel involves sacrifice, it is a story of one person's death bringing life to others. This is our little taste of it, for today, the real grief of separation in spite of the good it brings.

Monday, October 12, 2009

This was a long-weekend break with our family all together, designed to be about fun and togetherness, but in God's mercy we are thankful that the last day has been one of healing. Prayer. MANY hours of sleep, small forays back into eating and drinking, sun, quiet. A few dozen tablets of cipro all around. The wilted kids have revived, and we are very grateful to have one more day together relatively healthy .. . As one of the kids reminded us, our original plan for this break had been to pioneer the Juba/bus route to Mundri, South Sudan .. hard to imagine what a disaster THAT would have been. Grateful for unseen and unanticipated pushes from one plan to the next, protection of those with the least body reserves in our family and team (except Assusi .. ), and just this space to heal.

Saturday, October 10, 2009

5 am Thursday: an hour before we planned to get up and leave, Jack wakes up with violent spasms of vomiting, over and over. By the time we pack the car, Julia is similarly stricken. I'm juggling basins and splashing bleach as Assusi emerges from her room with similar symptoms. We know we are doomed.

3 pm Arrive in Entebbe, no one has eaten all day, we have stopped along the road at least ten times for uncontrollable explosions from both ends. Jack is burning with fever, I can't stay awake, and Scott's hope of being by-passed is dashed when a cup of tea sends him running to the bathroom.

5 pm We talk to our team and find out that 9 of 9 people who ate the ice cream I oh-so-generously made and shared last night are down. I feel like a murderer. For years I used my parents' technique which included raw eggs . . .but during one of JD's pregnancies I worried about salmonella and started cooking the custard. We've never been sick from it before. I got sloppy--threw the eggs into the hot milk, but rapidly took it off to cool. Seems there was something brewing, and now most of my family and team are paying the price. We tell our kids to try not to look sick . . there is a fair amount of swine flu paranoia, and this is clearly food poisoning, and we can just envision being turned away from our flight to Kenya. Our cover is blown when Jack vomits dramatically right on the floor in the airport as we rush to find a trash can. Misery.

7 pm. Jack and Julia lie on the floor, anywhere they can, in the airport. "They're just so tired" I say to helpful people who enquire. They look pasty. We all avoid food and stay close to the bathroom. When we move from one line to another, nearer to the gate, we peel them off the filthy floor and the collapse at the next stop. Julia finishes her final stomach-emptying on the tarmac as we walk to the airplane.

10 pm The black cavelas (small polyethylene bags) I packed are lifesavers. But only 5, and they are soon in short supply. We make it to the guest house in Nairobi where Luke and Caleb are already waiting, asleep. I'm shaking with chills and fever by now, and Jack is up every hour.

5 am Friday: We never even carried our suitcases up the stairs, just left them by the door and collapsed into beds. Now we're back in the dark in a taxi to the airport for the early flight to the coast. Caleb is chipper in spite of the early hour, having slept through the night's distresses, and Luke is forgiving us for waking him . . .at least now we have two healthy sane people in our family. More lying on the floor, more running to the bathroom and not always making it in time. The departure area is stocked with a few uncomfortable plastic chairs and a mal-functioning PA system that emits a high pitched shriek for about 50 seconds out of every minute. This seems not to bother anyone but us.

8 am Land in Mombasa, then a 2 1/2 hour drive to our hotel. No one throws up. Amazing.

24 hours later: The fevers are losing intensity, and everyone has tentatively tried a few bites of food, though paid the price soon after. Luke and Caleb were able to windsurf while the rest of us slept. Frankly all we care about is a level clean bed and nearby facilities, and hope the boys can have some fun. Until we woke to pouring rain this morning, of course.

Wednesday, October 07, 2009

Mercifully, RVA has planned a mid-term break in every three-month term. Which forces our life into a pattern of six weeks work and a long weekend of rest, a sabbath-like rhythm. Tomorrow we will rise before light, drive all day to Entebbe, fly in the evening to Nairobi, and be reunited as a family. Then we will spend Friday to Tuesday at the Kenyan coast. The ocean is a very real metaphor of the powerful un-searchable depths of God's being. We are praying that a few days of sun, quiet, waves, fish, exercise, and togetherness will be restorative all around. The boys are coming out of a slew of exams, an exhausting soccer season, dull food, and lonely separation from family. We are coming out of one attack after the other, turbulence in team life and planning, old griefs and anticipated griefs, failing electronics, an over-capacity hospital, rumors of swine flu, and the messy early transition work for the new (to-be-discovered) head teacher. In other words, normal life, which tends to unravel us, and requires extended hours, weekly days, and occasional retreats of rest and removal. Praying for real rest of the body and soul, and family memories to sustain us for the next stretch!

Just as we took the risk of moving all our tables, chairs, balloons, posters, dishes, etc. outside on Sunday afternoon for Julia's party, the blazingly bright day began to rumble. Within 15 minutes clouds rolled in, and rain began. We live in relatively small (apartment-sized) homes, so when 25 or 30 people are over for a party, it is pretty essential to be able to go outside. I remember very vividly a similar rain-soaking Bday-drenching many years ago, and being completely undone. This time I won't say I was a paragon of calm virtue, but a decade in Bundi has had some effect, and I did have the presence of soul to keep praying "God, you know what we can handle, and how much this means to Julia, and this is completely out of our hands, so we trust you." Even though I didn't necessarily FEEL that way. Everyone helped ferry the plates and food inside, we sat on the floor, and the rain abated to a mild drizzle in time for games.

Rain on a party may not seem like a very noble trial for a missionary. But I think it is a concrete parable of so much of the faith-challenge of life. We are not usually risking death from ebola. We are instead, most days, facing interruption, disappointment, lack of control over plans, worry for our kids, the struggle to make things work out for everyone in the best way. We are, most days, hoping for a bit more sun and sadly soggy when the rain comes instead.

Whether it is other people's choices or needs, or mechanical failures, or sicknesses, or corruption, or lack of supplies, or muddy roads . . .there are many times we look up at the gathering clouds and wonder if we can manage yet another storm. These are the moments when we are called to say: I would not have chosen this rain, Lord, but you see more than I do, deeper and further and longer. So I can only choose to trust that you have not stopped it for good reasons which I may or may not ever understand. Help me to slosh on.

In Africa, Scott reminded me, rain is a blessing not an annoyance to party plans. So the prayer may be extended: help me not to just slosh on, but to find Your rainbow to climb through this rain, the splintering spectrum of light which makes even our daily disappointments moments of beauty.

Monday, October 05, 2009

Ever since John wisely roped Jack and Julia into helping with the chicken project here and there, Jack has been hooked. As one of the youngest missionaries on our team, it is not easy to find a niche that you are uniquely gifted for (fast, strong, and not afraid of getting dirty), and that most other people don't particularly want to do (intimate contact with messy birds). So for Jack, it is chick-catching. Every few weeks the new chicks have to be vaccinated, which involves grabbing them one at a time, 300 flustery squawking pecking mini-chickens, handing them to Pauline who immunizes them, then separating them from the others, until each has been dosed. This evening the chicks are five weeks old and getting their third round. Jack and Scott Will assisted Pauline, bare bleach-cleaned feet in the mud and wattle coop as the nervous chicks swirled around their ankles, and the calm Pauline directed the operation.

We celebrate the so-far-100% survival rate, no small thing. These chickens will eventually lay the eggs that will sustain many malnourished children at the health center, and boost the nutrition of AIDS-affected families. It was Stephanie's vision and Pauline's persistence, former intern Jenn Butz's grant, and lots of other people in between, but the project continues, and Jack is proud to participate. This afternoon we had our BundiNutrition meeting. Lammech reported on the 92 goats distributed so far in 2009, with 20 more to go soon. Amazingly we now are able to purchase the majority locally, because of breeding programs initiated via the Matiti branch of BundiNutrition (which means that the goat-donation money not only benefits a new motherless or HIV-infected child's family, but also a former family who now is able to breed and sell goats from the one they received, so all the funding stays within the district!). Lammech and John share a vision for expanding the general upgrade of Bundibugyo goat genetics, so that hundreds, even thousands, of kids could drink milk instead of just the most severely malnourished. We talked about the record-keeping and breeding, and how a fourth extension worker could be an asset to this vision. Baguma Charles talked about the BBB program, and other needy areas of the district where the local production and provision of supplemental protein could make an impact. Pauline, Lammmech, and Baguma Charles are all great gifts to this work, people of skill and integrity that invest their lives here with us.

Monday's promise of protein, from the new admission of yet another malnourished baby at the hospital in the morning, to the lofty long view of program planning and funding in the afternoon, to the scratch-in-the-dirt reality of the chicken coop in the evening.

It seems that here on earth, we have to do a lot of tinkering. Some of it relatively trivial, and some not, but in a splintering world that tends to disorder, energy is constantly required for survival. In our life, much of that falls to Scott. If it's not the motorcycle it's the fridge, if it's not the fridge it's the cow, if it's not the cow it's something else. Everyday something breaks or goes wrong, and if it can be pieced back together in ten minutes we rejoice; if it sucks in the entire day we moan; and if it's beyond repair we wonder if we can just do without it. Today's issue is the internet WAP, the little transmitter that allows the rest of the team to connect to the signal that is based at our house. It is located in a high central point, namely just under the roof-ridge of the Community Center. And in last night's Julia-Bday-storms, it gave up the ghost at last, after about five years of service. So Scott had to search out a ladder to extend up 25 feet, risk the cloud of disturbed bats, and is now spending the rest of the day trying to resurrect some old equipment to replace the broken parts. Of course it is important for our team to have their life-line to family and friends, but it is also tearing a pretty large hole in the fabric of the week . . .

Some things are a bit more important to fix. Balyejukia Godfrey is 17, though he looks like he's 12. He must have contracted Rheumatic Fever sometime in his early years, because his heart is now severely affected. He is surviving but definitely not thriving, because he needs a new mitral valve (at least). This surgery is not possible yet in Uganda, though for about 15 thousand dollars it is possible to go to India. For a family in Bundibugyo, 15 thousand dollars, 5 thousand dollars, a million dollars, it is all unthinkably out of reach. Teenage boys hit close to MY heart these days, so when he came to see me a couple of weeks ago I went on-line and found out that various hospitals like UNC and DC Children's send teams to Mulago here in Uganda to evaluate patients, and that Samaritan's Purse has a program to assist needy children who have to be sent out of the country for surgery. And by grace it turns out that a team is coming next week, and agreed to evaluate our patient. We are praying that he is chosen for care, soberly aware that not all the children who need cardiac surgery in Uganda will get it.

Fixing the internet, or fixing a heart. Fixing the internet signal SO that we can connect a patient to a potential fix for his heart.

It strikes me that God does not offer a fix, but a new creation. Create in me a clean heart, oh God. He is not in the business of tinkering for survival, but in radically restoring, in making all things new. Hoping.

Sunday, October 04, 2009

Julia came into our family 13 years ago, taking her sweet time 2 weeks past her due date. She still hates to be rushed. She values friendship, finds joy in being helpful, holds her own against the boys on the football pitch, practices simple hymns on the piano, sets a lovely and hospitable table every night, makes her opinions clear when her brother gets in her way, writes descriptively, and frequently needs a hug. She has a passion for trees, and one of her gifts was tree seeds which she plans to nurture into seedlings. She is more concerned with practicality than fashion, and her signature look is the bandana. Her only request for a Bday gift: a pocket knife, like her brothers have, which comes in very handy camping. Hmmm, not the average 13-year-old-girl gift, but I well remember the thrill of a good pocket knife. So we ordered one on the internet and had Scott Will bring it, and her face just lit up. And as she opened it, I thought, not a bad thing for a girl who is as beautiful, friendly, and integrated into the culture as Julia is, to be armed. Sigh.

Though she's 13 and looking like 16, she's a kid at heart. She chose a "Phantom Tollbooth" theme for her party, which is a fantastic little book that is a must-read for 7 to 70 year olds. We have a very game team, and everyone dressed up at characters from the book, and participated good-naturedly in games ranging from an auditory charades (guess the sound), to creating a wild paragraph out of a pile of random words, to a "jump to conclusions" bag-race relay. We tried to beat the inevitable evening rain by planning a mid-day party, but alas, as soon as we carried everything outside into the bright sunshine storm clouds rolled in, thunder rumbled, and we were driven back inside, which was a bit discouraging. Still, the most fun for Julia was setting up all the balloons and decorations, even if they did get drenched. And the rain did lighten to a misting sprinkle in time for the games.

It was a full and fun day, wholesome and encouraging and community-oriented. The same three girl-friends who have been at almost every Bday for Julia since she was a baby joined her in addition to a couple of other kids and the whole team. Julia is a precious jewel in our lives, and I am very thankful for the willingness of so many people to gather around her and honor her today.

Saturday, October 03, 2009

Dissonance is the darker side of paradox. Saturday was a day of dissonance. Most of the day was one of preparation and anticipation, for Julia's birthday. She has reminded us a hundred times this week of the countdown to the day, which for her is made special by friends, team, a party, costumes, games, the experience of the day. And for us that means posters, baking, designing, organizing for Sunday afternoon fun. But in the midst of that, we got news that our friend Chris Kenobwa had lost another child. This is the second who has died this year, and he is the same man who broke his ankle and hurt his back falling out of a tree he was cutting down. Ammon was six, and though he suffered from sickle cell disease he grew well and seemed to have less problems than most. But he became suddenly ill Friday night and died in the early darkness of Saturday morning. Scott, Pat, and I walked over to our neighbors, and sat. It was eerily quiet, an exhausted grief, with the women crowded into a closet-sized room in the mud hut, Ammon's face visible in the open crudely cobbled coffin. I don't know if it was his body or the press of live un-health in the room, but there was a putrid smell in the mid-day sun. As our pastor Kisembo bravely proclaimed Jesus' love for children, Ammon's mother screamed out her wail and he father Chris sat deflated outside the house. Then we returned to the skipping joy of our kids in their eager pre-party projects.

This is the dissonance of life. Surrounded by the odor of death, cut with the grief of loss, yet in the midst of that preparing for the ultimate party, the feast on the mountain, the wines on the lees and choice pieces, the no-tears end to the whole story.

Exuberant even jet lagged, the indomitable Scott Will has returned. He was our ebola-companion, and walked through some of our life's darkest days with us. God has been good to send him back to Bundi for three months, en route to long term service in Sudan on the Masso's team. We are celebrating!

Friday, October 02, 2009

This is the happy ending to a long story. Readers may remember Paulo, a little boy who was born with abnormal valves in his urethra that blocked his ability to urinate. His mother is one of the most persistent ladies I have met. In the face of widespread fatalism and weariness when the system fails to work, most people succumb to a lethargic and uneasy compromise with reality. Life is difficult and unfair, and there's not much hope of changing that. But not Paulo's mom, who knew that the painful dribbling urine her little boy eeked out was not normal, and not being treated by hastily scrawled prescriptions of antibiotics. By the time she landed on our ward he had some damage to his kidneys. But the struggle had just begun.

We referred him two years ago for the relatively straight-forward surgical procedure of ablating the problematic valves, i.e. getting them out. Instead the only urologist in the country performed a simpler procedure, an opening in his abdominal wall so that urine passed directly out of his bladder and onto his skin and clothes. This saves the damaging back-pressure on his kidneys, but is a socially untenable long-term solution. Over the course of the next year we sent him back to Mulago six times, the national referral hospital where citizens should get specialized care, free. Each time he was sent back with an excuse of why surgery could not be done. Once he spent TWO MONTHS admitted, was discharged with a note that he could not urinate, and told to come back in a week. In desperation we hooked him up with the private hospital in Kampala, IHK. However it turned out that they consulted the SAME urologist who was suddenly available to do the surgery he'd put off six times, but for an exorbitant fee.

Well, Paulo's mom met her angels at last, two more persistent Ugandan women. A woman named Rose, who bravely walked away from a life of witchcraft and sacrifices as a teen, to look for a better one. She was adopted by an Irish medical missionary couple, sent to nursing school, and founded a charity called Hope Ward at IHK (her dad's hospital). This visionary and passionate woman just held a huge fundraiser, to protest child sacrifice, a walk-athon of the route of her escape, and donated the money to Hope Ward. And a woman named Jemimah, who connects patients with the care they need on the ward, makes the phone calls and appointments. She found an alternative surgeon, and Paulo finally had his surgery earlier this year.

For the first time in his five years, he could urinate. But post-op, the old opening that had been made in his abdominal wall and then closed, began to leak. A few months ago we made a plan for him to return in October for a second surgery. On exactly the first day of October, Paulo and his mom showed up at our house. I thought they wanted to go back to Kampala. Instead his mom explained that God had healed Paulo, the old wound was closed, he no longer leaked through his stomach. He pees like any other 5-year-old boy.

It was a long saga, for one little boy, and I'm glad for his sake that it is finally over. The damaged kidneys will probably come back to trouble him eventually, but without the surgery he could have been dead by now. A big thanks to Hope Ward, Rose, Jemimah, the Clarks, and all the people in Uganda who stand against corruption and despair, and work to make things different.

Our Mission

who we are

paradox:
1. something that combines contradictory features or qualities.
Life in Africa is full of contradictions - the beauty and pain; the abundance and the poverty; the joy and the sorrow.
Our lives, too...dying that we might live; strong in our weakness; sinners yet saints.
2. a "pair of docs"